title: Outcomes and survival analysis of old-to-old simultaneous pancreas and kidney transplantation.
abstract: Outcomes of old-donor simultaneous pancreas-kidney transplantation (SPKT) have not been thoroughly studied. Scientific Registry of Transplant Recipients data reported for SPKT candidates receiving dialysis wait-listed between 1993 and 2008 (n = 7937) were analyzed for outcomes among those who remained listed (n = 3301) and of SPKT recipients (n = 4636) using multivariable time-dependent regression models. Recipients were stratified by donor/recipient age (cutoff 40 years) into: young-to-young (n = 2099), young-to-old (n = 1873), old-to-young (n = 293), and old-to-old (n = 371). The overall mortality was 12%, 14%, 20%, and 24%, respectively, for those transplanted, and 50% for those remaining on the waiting list. On multivariable analysis, old-donor SPKT was associated with significantly higher overall risks of patient death, death-censored pancreas, and kidney graft failure in both young (73%, 53%, and 63% increased risk, respectively) and old (91%, 124%, and 85% increased risk, respectively) recipients. The adjusted relative mortality risk was similar for recipients of old-donor SPKT compared with wait-listed patients including those who subsequently received young-donor transplants (aHR 0.95; 95% CI 0.78, 1.12) except for candidates in OPOs with waiting times ≥604 days (aHR 0.65, 95% CI 0.45-0.94). Old-donor SPKT results in significantly worse graft survival and patient mortality without any waiting-time benefit as compared to young-donor SPKT, except for candidates with expected long waiting times.
authors.affiliation: Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Liise K
authors.initials: LK
authors.lastname: Kayler
authors.forename: Xuerong
authors.initials: X
authors.lastname: Wen
authors.forename: Mareena
authors.initials: M
authors.lastname: Zachariah
authors.forename: Michael
authors.initials: M
authors.lastname: Casey
authors.forename: Jesse
authors.initials: J
authors.lastname: Schold
authors.forename: Joseph
authors.initials: J
authors.lastname: Magliocca
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000379:methods; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
keywords: age matching; pancreas transplantation